Evaluation of affordable screening markers to detect CD4+ T-cell counts below 200 cells/μl among HIV-1-infected Ugandan adults
Tropical Medicine and International Health
MRC/UVRI, Uganda Research Unit on Aids in Uganda, PO Box 49, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, United Kingdom
Objective: To evaluate validity of WHO staging, low body mass index (BMI) and anaemia in detecting HIV-infected adults with CD4+ T-cell counts < 200 cells/μl. Methods: Between October 1995 and April 2006, we screened Ugandans aged 16 or older at enrolment into an open cohort. We analysed highly active anti-retroviral therapy (HAART)-naïve HIV-infected patients with WHO stages 1-3 and complete data in a secondary cross-sectional study. Low BMI was a BMI < 18.5 kg/m 2. Anaemia was a haemoglobin level < 11 or 12 g/dl among women and men respectively. Results: Among 2892 HAART-naïve patients, the median age was 32 years. 71% were women, 54% had WHO stage 3 AIDS, 34% had anaemia, 16% had a low BMI and 43% had CD4+ T-cell counts < 200 cells/μl. WHO stage 3 compared to combined WHO stages 1 and 2 had a sensitivity (95% CI) of 70% (67, 72) and a specificity of 57% (55, 60) respectively to detect CD4+ T-cell counts < 200 cells/μl. Anaemia compared to normal haemoglobin had sensitivity (95% CI) of 47% (44, 50) and a specificity of 76% (74, 78). Low BMI compared to normal BMI had sensitivity (95% CI) of 23% (20, 25) and a specificity of 89% (87, 90) against CD4+ T-cell counts < 200 cells/μl. Conclusion: Only WHO stage 3 had reasonably high sensitivity in detecting CD4+ T-cell counts below 200 cells/μl in this setting. Targeted low-cost CD4 testing strategies are urgently needed to detect patients eligible for HAART in rural Africa and other resource-limited settings. © 2010 Blackwell Publishing Ltd.
biological marker; hemoglobin; age class; biomarker; body mass; human immunodeficiency virus; medical geography; spatiotemporal analysis; World Health Organization; acquired immune deficiency syndrome; adolescent; adult; aged; AIDS patient; anemia; article; body mass; CD4 lymphocyte count; controlled study; cost benefit analysis; cross-sectional study; disease marker; female; hemoglobin blood level; highly active antiretroviral therapy; human; Human immunodeficiency virus 1 infection; major clinical study; male; protein targeting; screening test; sensitivity and specificity; staging; Uganda; validation process; world health organization; Adolescent; Adult; Anemia; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Biological Markers; Body Mass Index; CD4 Lymphocyte Count; Cross-Sectional Studies; Female; Hemoglobins; HIV Infections; HIV-1; Humans; Male; Middle Aged; Sensitivity and Specificity; Uganda; World Health Organization; Young Adult; Uganda; Human immunodeficiency virus 1